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Bertie Joined: 28 Jun 2008 Posts: 4	Posted: Sun Jun 29, 2008 8:35 am    Post subject: Just a Question Hi! Just had a question about lab results. My results came back with: Tissue Transglutaminase Ab - 6.5 (expected value of <20.0) Endomysial Abs - Negative Gliadin IgA - 37.8 (<=25.0, Negative; 25.1-49.9, Equivocal; >= 50.0, Positive) Gliadin IgG - 63.0 (<25.0, Negative; 25.1-49.9, Equivocal; >= 50.0, Positive) Didn't really get much explanation from doctor about which of these results definitely confirmed celiac. She said from these results, I wouldn't need to have any further tests, it was definitely celiac, and turned me over to my family doctor. Does that sound right? Thanks for listening!
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cruelshoes Joined: 23 Sep 2005 Posts: 2550 Location: Washington State	Posted: Sun Jun 29, 2008 12:22 pm    Post subject: Hi, Bertie. I'm glad you stopped in with your bloodwork results. I am going to bombard you with a bunch of information. Sorry if it seems like a lot, but that's just how I roll. I am a little surprised that you were not told to go ahead with the biopsy in order to diagnose Celiac. Here is some information you may find helpful. Here is a little background that will help you make sense of it all. It is a description of the different types of antibodies. Quote: IgA. IgA antibodies are found in areas of the body such the nose, breathing passages, digestive tract, ears, eyes, and vagina. IgA antibodies protect body surfaces that are exposed to outside foreign substances. This type of antibody is also found in saliva and tears. About 10% to 15% of the antibodies present in the body are IgA antibodies. A small number of people do not make IgA antibodies. IgG. IgG antibodies are found in all body fluids. They are the smallest but most common antibody (75% to 80%) of all the antibodies in the body. IgG antibodies are very important in fighting bacterial and viral infections. IgG antibodies are the only type of antibody that can cross the placenta in a pregnant woman to help protect her baby (fetus). IgM. IgM antibodies are the largest antibody. They are found in blood and lymph fluid and are the first type of antibody made in response to an infection. They also cause other immune system cells to destroy foreign substances. IgM antibodies are about 5% to 10% of all the antibodies in the body. IgE. IgE antibodies are found in the lungs, skin, and mucous membranes. They cause the body to react against foreign substances such as pollen, fungus spores, and animal dander. They may occur in allergic reactions to milk, some medicines, and some poisons. IgE antibody levels are often high in people with allergies. IgD. IgD antibodies are found in small amounts in the tissues that line the belly or chest. How they work is not clear. Your TtG is slightly elevated. Tissue Transglutaminase antibodies may be an indicator of CD, but there are other conditions which can cause it to be elevated. http://www.celiacdisease.net/assets/pdf/CDCFactSheetsAntibodyScreening3.pdf Quote: It is important to note that some people with Type 1 Diabetes, Hashimoto’s thyroiditis and autoimmune liver conditions can have a falsely positive tissue transglutaminase test. For this reason, it is important that tTG test results in people with these conditions be checked with the EMA test. The physician may nevertheless want to obtain an intestinal biopsy if clinically indicated, even if EMA are negative. Your AGA IgA and IgG are both elevated. Here is some information on those tests. First some information on the Anti Gliadin antibodies: http://www.americanceliac.org/diagnosis.htm Quote: What are the different antibody tests available? Can there be errors in testing? The blood tests can be divided into 2 different types of antibodies: those which are “anti-gluten”, and those that “anti-self”. The “anti-gluten” antibodies are the anti-gliadin IgG and IgA. Ig stands for “immunoglobulin” or “antibody”. The “anti-self” antibodies are anti-endomysial IgA and anti-tissue transglutaminase IgA. *** Antigliadin antibodies The antigliadin antibodies IgG and IgA recognize a small piece of the gluten protein called gliadin. These antibodies became available during the late 1970’s and were the first step towards recognizing CELIAC DISEASE as an autoimmune disorder. Antigliadin IgG has good sensitivity, while antigliadin IgA has good specificity, and therefore their combined use provided the first reliable screening test for CELIAC DISEASE. The IgG test is highly sensitive, but is less specific to celiac disease. THe IgA test is highly specific, but less sensitive. The problem with the antigliadin antibodies is that other things besides celiac can cause them to be elevated. http://www.celiacdiseasecenter.columbia.edu/C_Doctors/C05-Testing.htm Quote: Causes of false positive celiac serologic tests The endomysial antibody test is virtually 100% specific for celiac disease. However anti-tTG has been reported to be positive in the presence of liver disease, especially cirrhosis [33], diabetes [34, 35] and severe heart failure [36], as well as arthritis [37] and various autoimmune disorders [38]. The use of human tTG as the antigen in the test kit adds some greater specificity. Antigliadin antibodies may be present in inflammatory bowel disease [39], collagen vascular disease [40], and in many healthy people as well [41]. This link is a little older, but does have some relevant portions. http://www.celiac.com/articles/57/1/Interpretation-of-Celiac-Disease-Blood-Test-Results/Page1.html Quote: Anti-Gliadin Antibodies: Both IgA and IgG anti-gliadin antibodies (AGA) are detected in sera of patients with gluten sensitive enteropathy (celiac disease). IgG anti-gliadin antibodies are more sensitive but are less specific markers for disease compared with IgA class antibodies. IgA anti-gliadin antibodies are less sensitive but are more specific. In clinical trials, the IgA antibodies have a specificity of 97% but the sensitivity is only 71%. That means that, if a patient is IgA positive, there is a 97% probability that they have celiac disease. Conversely, if the patient is IgA negative, there is only a 71% probability that the patient is truly negative for celiac disease. Therefore, a positive result is a strong indication that the patient has the disease but a negative result does not necessarily mean that they don not have it. False positive results are rather uncommon but false negative results can occur. On the other hand, the IgG anti-gliadin antibodies are 91% specific and have an 87% sensitivity. This means that they will show positive results more readily but there is not as strong a correlation with celiac disease. It is less specific. Patients with other conditions but not afflicted with celiac disease will occasionally show positive results. IgG anti-gliadin antibodies are detectable in approximately 21% of patients with other gastrointestinal disorders. This test might yield false positive results but is less likely to yield false negative results. In general. a celiac diagnosis is not made based on the AGA results alone. It simply is not specific enough to make a difinitive diagnosis. It may be an indicator that you are producing antibodies to gluten. It can be used as an indicator to proceed to the biopsy. See link below. Seronegative celiac disease Quote: Both the anti-tTG and the EMA titers correlate with the severity of villous atrophy [26-29]. As a result in the presence of partial villous atrophy either antibody may be negative. In addition the mode of presentation of the celiac disease, i.e. presence of silent or subclinical celiac disease may be associated with a negative EMA [30]. Clinically seronegative celiac disease is similar to sero-positive celiac disease [23, 28] In view of the possibility of the presence of celiac disease in the absence of a positive anti-tTG or endomysial antibody the presence of a positive IgA AGA should prompt a biopsy [13]. Several studies have demonstrated that reliance on either anti-tTG or endomysial antibody as a single test will underestimate the prevalence of celiac disease [23, 25, 31, 32]. What I don't see from the information you posted above is your Total serum IgA. If your IgA is very low or you are IgA deficient, your doctor has to rely on IgG results. You have posted one IgG result above. There is also an IgG version of the EMA and TtG scores, which I also don't see. http://www.celiacdisease.net/assets/pdf/CDCFactSheetsAntibodyScreening3.pdf Quote: People with IgA deficiency require a different version of the antibody tests listed above. The tTG and EMA tests have IgG versions and these tests will then be accurate for someone with IgA deficiency. IgA deficiency is diagnosed when someone has a total serum IgA test and the results are very close to zero. This is not a test for celiac disease, but a means to make a more accurate diagnosis. I hope that made some sense and wasn't too much information. Gluten may be a problem for you. If it were me, I would ask my doctor why we were dispensing with the biopsy, which is currently considered the "gold standard" for diagnosis. I am not an expert, nor am I a doctor, so take this information with that in mind. _________________ -Colleen Dx 8/05 via bloodwork/biopsy 10-YO son Dx 11/05 via bloodwork/biopsy Daughters (12 and 2) have neg. bloodwork A woman is like a tea bag-you never know how strong she is until she gets in hot water. - Eleanor Roosevelt Last edited by cruelshoes on Sun Jun 29, 2008 1:23 pm; edited 1 time in total
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Bertie Joined: 28 Jun 2008 Posts: 4	Posted: Sun Jun 29, 2008 12:48 pm    Post subject: Thank you so much! The more information, the better, I always say! I definitely have some questions for the doctor. . .
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Bertie Joined: 28 Jun 2008 Posts: 4	Posted: Sun Jun 29, 2008 12:52 pm    Post subject: Oh, sorry, forgot to add the total serum IgA was 146 (range 70-400). Thanks, again!
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cruelshoes Joined: 23 Sep 2005 Posts: 2550 Location: Washington State	Posted: Sun Jun 29, 2008 1:59 pm    Post subject: OK - then you are not IgA deficient. I hope you get to the bottom of things. Please don't take the info I posted as a judgment that you do not have celiac or a gluten intolerance. It is just that there are some pieces to the puzzle that may help you see the total picture. _________________ -Colleen Dx 8/05 via bloodwork/biopsy 10-YO son Dx 11/05 via bloodwork/biopsy Daughters (12 and 2) have neg. bloodwork A woman is like a tea bag-you never know how strong she is until she gets in hot water. - Eleanor Roosevelt
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aklap Joined: 02 Oct 2004 Posts: 8607 Location: WI, USA	Posted: Sun Jun 29, 2008 4:19 pm    Post subject: Hi Bertie, Welcome to the board! Colleen has assembled some great info for you. I too find it interesting that your doc did not order an EDG to obtain intestine samples. Some docs will rely on blood work and improvement of symptoms during a GF trial and offer up a diagnosis of CD. I will give kudos to your doc for running the AGA tests. Many docs won't run them because they have fallen out of favor. The tTG and EMA tests are much more specific to CD. Have you started your GF diet yet? Good luck, please don't be afraid to ask questions. _________________ Al “We cannot all do great things, but we can do small things with great love.” Mother Teresa
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Bertie Joined: 28 Jun 2008 Posts: 4	Posted: Mon Jun 30, 2008 6:19 am    Post subject: Thanks, everyone, for your responses! I have started the diet, and realized that gluten is everywhere! It is amazing, all the little hidden sources out there.
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cruelshoes Joined: 23 Sep 2005 Posts: 2550 Location: Washington State	Posted: Mon Jun 30, 2008 7:00 am    Post subject: Just a word of caution. If you want to proceed to the biopsy, you must continue eating gluten. If you don't, you run the risk of healing up enough to have a false negative. That's one more thing for you to discuss with your doctor. _________________ -Colleen Dx 8/05 via bloodwork/biopsy 10-YO son Dx 11/05 via bloodwork/biopsy Daughters (12 and 2) have neg. bloodwork A woman is like a tea bag-you never know how strong she is until she gets in hot water. - Eleanor Roosevelt
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